Pleural empyema classification: Difference between revisions
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==Overview== | ==Overview== | ||
[[Empyema]] may be classified according to the etiology, anatomical location, and pathological course of the disease.<ref name="pmid7634854">{{cite journal| author=Light RW| title=A new classification of parapneumonic effusions and empyema. | journal=Chest | year= 1995 | volume= 108 | issue= 2 | pages= 299-301 | pmid=7634854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7634854 }} </ref> Primary thoracic [[empyema]] occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary [[empyema]] happens more commonly secondary to pneumonia. Empyema necessitans is a spontaneous discharge of an [[Empyema Thoracis|empyema]] that has burrowed through the [[parietal pleura]] into the chest wall to form a [[subcutaneous]] [[abscess]] that may eventually rupture through the skin.<ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of [[pulmonary tuberculosis]]. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue= | pages= | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441 }} </ref><ref name="pmid17301589">{{cite journal| author=Ahmed SI, Gripaldo RE, Alao OA| title=Empyema necessitans in the setting of pneumonia and parapneumonic effusion. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 2 | pages= 106-8 | pmid=17301589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17301589 }} </ref> [[Empyema]] is mostly caused by bacteria. It may be [[tuberculous]] or [[Nontuberculous mycobacteria|nontuberculous]]. [[Tuberculous]] [[empyema]] is the most common cause of [[empyema]] necessitans with majority of affected patients being immunocompromised.<ref name="pmid27555974">{{cite journal| author=Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F| title=Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male. | journal=Case Rep Infect Dis | year= 2016 | volume= 2016 | issue= | pages= 4187108 | pmid=27555974 | doi=10.1155/2016/4187108 | pmc=4983337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555974 }} </ref><ref name="pmid27477414">{{cite journal| author=Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T et al.| title=Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2055-9 | pmid=27477414 | doi=10.2169/internalmedicine.55.6672 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477414 }} </ref> There are 3 stages of empyema which are important in terms of the laboratory findings. These are [[exudative]], fibrinopurulent and organizing.<ref name="pmid2480911">{{cite journal| author=Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA| title=The histology of experimental pleural injury with tetracycline, empyema, and carrageenan. | journal=Exp Mol Pathol | year= 1989 | volume= 51 | issue= 3 | pages= 205-19 | pmid=2480911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2480911 }} </ref> | [[Empyema]] may be classified according to the etiology, anatomical location, and pathological course of the disease.<ref name="pmid7634854">{{cite journal| author=Light RW| title=A new classification of parapneumonic effusions and empyema. | journal=Chest | year= 1995 | volume= 108 | issue= 2 | pages= 299-301 | pmid=7634854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7634854 }} </ref> Primary thoracic [[empyema]] occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary [[empyema]] happens more commonly secondary to pneumonia. Empyema necessitans is a spontaneous discharge of an [[Empyema Thoracis|empyema]] that has burrowed through the [[parietal pleura]] into the chest wall to form a [[subcutaneous]] [[abscess]] that may eventually rupture through the skin.<ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of [[pulmonary tuberculosis]]. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue= | pages= | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441 }} </ref><ref name="pmid17301589">{{cite journal| author=Ahmed SI, Gripaldo RE, Alao OA| title=Empyema necessitans in the setting of pneumonia and parapneumonic effusion. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 2 | pages= 106-8 | pmid=17301589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17301589 }} </ref> [[Empyema]] is mostly caused by bacteria. It may be [[tuberculous]] or [[Nontuberculous mycobacteria|nontuberculous]]. [[Tuberculous]] [[empyema]] is the most common cause of [[empyema]] necessitans with majority of affected patients being [[immunocompromised]].<ref name="pmid27555974">{{cite journal| author=Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F| title=Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male. | journal=Case Rep Infect Dis | year= 2016 | volume= 2016 | issue= | pages= 4187108 | pmid=27555974 | doi=10.1155/2016/4187108 | pmc=4983337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555974 }} </ref><ref name="pmid27477414">{{cite journal| author=Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T et al.| title=Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2055-9 | pmid=27477414 | doi=10.2169/internalmedicine.55.6672 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477414 }} </ref> There are 3 stages of empyema which are important in terms of the laboratory findings. These are [[exudative]], fibrinopurulent and organizing.<ref name="pmid2480911">{{cite journal| author=Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA| title=The histology of experimental pleural injury with tetracycline, empyema, and carrageenan. | journal=Exp Mol Pathol | year= 1989 | volume= 51 | issue= 3 | pages= 205-19 | pmid=2480911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2480911 }} </ref> | ||
==Classification== | ==Classification== | ||
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===Empyema necessitans=== | ===Empyema necessitans=== | ||
Empyema necessitans is a spontaneous discharge of an empyema that has burrowed through the parietal pleura into the chest wall to form a [[subcutaneous]] [[abscess]] that may eventually rupture through the skin.<ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of pulmonary tuberculosis. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue= | pages= | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441 }} </ref><ref name="pmid17301589">{{cite journal| author=Ahmed SI, Gripaldo RE, Alao OA| title=Empyema necessitans in the setting of pneumonia and parapneumonic effusion. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 2 | pages= 106-8 | pmid=17301589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17301589 }} </ref> | Empyema necessitans is a spontaneous discharge of an empyema that has burrowed through the parietal [[pleura]] into the chest wall to form a [[subcutaneous]] [[abscess]] that may eventually rupture through the skin.<ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of pulmonary tuberculosis. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue= | pages= | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441 }} </ref><ref name="pmid17301589">{{cite journal| author=Ahmed SI, Gripaldo RE, Alao OA| title=Empyema necessitans in the setting of pneumonia and parapneumonic effusion. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 2 | pages= 106-8 | pmid=17301589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17301589 }} </ref> | ||
===Tuberculous vs nontuberculous empyema=== | ===Tuberculous vs nontuberculous empyema=== | ||
[[Tuberculous]] empyema is the most common cause of [[empyema]] necessitans. This disease can be found in patients with impaired immunity or who are immunocompetent | [[Tuberculous]] empyema is the most common cause of [[empyema]] necessitans. This disease can be found in patients with impaired [[immunity]] or who are [[immunocompetent]] however majority of patients affected are [[immunocompromised]].<ref name="pmid27555974">{{cite journal| author=Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F| title=Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male. | journal=Case Rep Infect Dis | year= 2016 | volume= 2016 | issue= | pages= 4187108 | pmid=27555974 | doi=10.1155/2016/4187108 | pmc=4983337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555974 }} </ref><ref name="pmid27477414">{{cite journal| author=Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T et al.| title=Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2055-9 | pmid=27477414 | doi=10.2169/internalmedicine.55.6672 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477414 }} </ref> | ||
==Stages of empyema== | ==Stages of empyema== | ||
| Line 25: | Line 25: | ||
In the exudative stage, the pus accumulates, and initial sterile fluid becomes infected with fluid characteristics of; | In the exudative stage, the pus accumulates, and initial sterile fluid becomes infected with fluid characteristics of; | ||
** | **[[Glucose]]>60 | ||
**pH>7.2 | **[[pH]]>7.2 | ||
**LDH<500 | **[[Lactate dehydrogenase|LDH]]<500 | ||
*Fibrinopurulent | *Fibrinopurulent | ||
During this stage, bacterial multiplies with increase in polymorphs and fibrin deposition on both pleural surfaces with fluid characteristics of; | During this stage, bacterial multiplies with increase in polymorphs and [[fibrin]] deposition on both [[pleural]] surfaces with fluid characteristics of; | ||
**glucose<40 | **[[glucose]]<40 | ||
**pH <7.2 | **[[pH]] <7.2 | ||
**LDH>1000 | **[[Lactate dehydrogenase|LDH]]>1000 | ||
*Organizing | *Organizing | ||
This stage is characterized by loculations, inelastic membranous peel, and lung entrapment as a result of scarring of the pleural space.<ref name="pmid2480911">{{cite journal| author=Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA| title=The histology of experimental pleural injury with tetracycline, empyema, and carrageenan. | journal=Exp Mol Pathol | year= 1989 | volume= 51 | issue= 3 | pages= 205-19 | pmid=2480911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2480911 }} </ref> | This stage is characterized by loculations, inelastic membranous peel, and lung entrapment as a result of scarring of the [[pleural space]].<ref name="pmid2480911">{{cite journal| author=Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA| title=The histology of experimental pleural injury with tetracycline, empyema, and carrageenan. | journal=Exp Mol Pathol | year= 1989 | volume= 51 | issue= 3 | pages= 205-19 | pmid=2480911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2480911 }} </ref> | ||
==References== | ==References== | ||
Revision as of 05:05, 9 March 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Empyema may be classified according to the etiology, anatomical location, and pathological course of the disease.[1] Primary thoracic empyema occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary empyema happens more commonly secondary to pneumonia. Empyema necessitans is a spontaneous discharge of an empyema that has burrowed through the parietal pleura into the chest wall to form a subcutaneous abscess that may eventually rupture through the skin.[2][3] Empyema is mostly caused by bacteria. It may be tuberculous or nontuberculous. Tuberculous empyema is the most common cause of empyema necessitans with majority of affected patients being immunocompromised.[4][5] There are 3 stages of empyema which are important in terms of the laboratory findings. These are exudative, fibrinopurulent and organizing.[6]
Classification
Empyema may be classified according to the etiology, anatomical location/organ, and pathological course of the disease as follows:[1]
Primary vs secondary empyema
Primary empyema occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary empyema happens more commonly secondary to pneumonia.
Empyema necessitans
Empyema necessitans is a spontaneous discharge of an empyema that has burrowed through the parietal pleura into the chest wall to form a subcutaneous abscess that may eventually rupture through the skin.[2][3]
Tuberculous vs nontuberculous empyema
Tuberculous empyema is the most common cause of empyema necessitans. This disease can be found in patients with impaired immunity or who are immunocompetent however majority of patients affected are immunocompromised.[4][5]
Stages of empyema
Empyema may be classified according to the stage of the disease as follows:[7]
- Exudative
In the exudative stage, the pus accumulates, and initial sterile fluid becomes infected with fluid characteristics of;
- Fibrinopurulent
During this stage, bacterial multiplies with increase in polymorphs and fibrin deposition on both pleural surfaces with fluid characteristics of;
- Organizing
This stage is characterized by loculations, inelastic membranous peel, and lung entrapment as a result of scarring of the pleural space.[6]
References
- ↑ 1.0 1.1 Light RW (1995). "A new classification of parapneumonic effusions and empyema". Chest. 108 (2): 299–301. PMID 7634854.
- ↑ 2.0 2.1 Gomes MM, Alves M, Correia JB, Santos L (2013). "Empyema necessitans: very late complication of [[pulmonary tuberculosis]]". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-202072. PMC 3863066. PMID 24326441. URL–wikilink conflict (help)
- ↑ 3.0 3.1 Ahmed SI, Gripaldo RE, Alao OA (2007). "Empyema necessitans in the setting of pneumonia and parapneumonic effusion". Am J Med Sci. 333 (2): 106–8. PMID 17301589.
- ↑ 4.0 4.1 Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F (2016). "Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male". Case Rep Infect Dis. 2016: 4187108. doi:10.1155/2016/4187108. PMC 4983337. PMID 27555974.
- ↑ 5.0 5.1 Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T; et al. (2016). "Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema". Intern Med. 55 (15): 2055–9. doi:10.2169/internalmedicine.55.6672. PMID 27477414.
- ↑ 6.0 6.1 Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA (1989). "The histology of experimental pleural injury with tetracycline, empyema, and carrageenan". Exp Mol Pathol. 51 (3): 205–19. PMID 2480911.
- ↑ Reichert M, Hecker M, Witte B, Bodner J, Padberg W, Weigand MA; et al. (2016). "Stage-directed therapy of pleural empyema". Langenbecks Arch Surg. doi:10.1007/s00423-016-1498-9. PMID 27815709.